My work investigates the impact of the diffusion of genomic information into clinical and public health contexts. I am particularly interested in studying genomic communication relevant to diseases or populations that are stigmatized and/or underserved. I examine these issues both in simulated clinical contexts, and online through social media platforms. I currently have several ongoing or recently completed studies that contribute to these aims. In the clinical context, my colleagues and I have mounted a study to assess the benefits and/or risks of a physician introducing obesity genomics information into clinical weight-management encounters (Weight Management Interaction Study; NHGRI protocol # 11-HG-0238). We are interested in how this information will influence patients health-related attitudes, beliefs, behavior, and patient perceptions of stigmatization. The project also aims to determine whether a physicians patient-centered versus doctor-centered approach to a health care encounter could mitigate or amplify the potential negative and positive consequences of genomic information provision. This study is being conducted in an immersive virtual reality-based clinical simulation in the Immersive Virtual Environment Testing Area. During this reporting year, we have completed all data collection inclusive of two pilot evaluation studies (n=20 and n=40), as well as the main experimental trial (n=204). We have one international conference presentation related to the main trial upcoming and have multiple manuscripts in preparation. In continuing to examine and inform provision of obesity-related genomic information in clinical encounters, colleagues and I have developed a study that assesses the impact of patient emotion on these processes. Emotions such as fear and anger arise in these clinical encounters from sources like receipt of risk information and perceptions of interpersonal treatment. Theoretically, the experience of emotion is expected to influence patient interpretation and reaction to genomic information provided by a physician. We have designed a two-pronged approach using both an internet-based and an immersive virtual reality-based simulation experiment to address these processes. Data collection for the virtual reality-based simulation study is currently ongoing, and data collection for the internet-based study will commence shortly. My work has also considered factors that modify patients receptivity to genomic information provided in the clinic for other health conditions. Colleagues and I previously collected data for an immersive virtual reality experimental study assessing the effect of racial concordance between physician and African-American patients on patient reaction to genomic-based cancer risk information (NHGRI protocol # 09-HG-0009). We demonstrated that African-American patients perceptions of their lung cancer risk were more accurate following an information provision session with a doctor who appeared to be Black than a doctor who appeared to be White. In addition, this effect was stronger for those patients who currently smoke. During this reporting year, a manuscript detailing this research was published. In addition to my experimental research related to communication about genomic information in the clinic, I also investigate issues around dissemination of genomic information in online and public health-related contexts. Together with Colleen McBride, I have experimentally investigated the effect on mothers of providing family history-based obesity risk feedback with respect to their young children (NHGRI protocol # 10-HG-0076), which is described in a separate report.In the online arena, my colleagues and I have published on one study during this reporting year - a quantitative coding analysis of publicly available postings on weight loss-themed online forums. This analysis demonstrated that individuals apply the genetic information they encounter through online social media to their own health beliefs and decisions.